The Journal of Bone and Joint Surgery, Vol 74, Issue 2 218-232, Copyright © 1992 by Journal of Bone and Joint Surgery, Inc
Open fractures of the diaphysis of the lower extremity in children. Treatment, results, and complications
KE Cramer, TJ Limbird and NE Green
Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2550.
We reviewed the results of treatment of forty open diaphyseal fractures of
the lower extremity in thirty-five children. The patients were between
three and sixteen years old, and they had been managed between 1980 and
1988. The minimum duration of follow-up was one year. Eighty-six per cent
of the patients had been injured in a motor-vehicle accident, and 74 per
cent had associated injuries. Thirty-one of the fractures were Grade-II
open or Grade-III open and seven were Grade-I open, according to the
classification of Gustilo and Anderson. Two patients who had initially had
a closed fracture were treated with a fasciotomy for a compartment
syndrome, so these two fractures were included as open. Four other patients
who had a Grade-II or III open fracture also needed a fasciotomy. All
wounds were treated with immediate and repeat debridement and early
soft-tissue coverage. Twenty-two fractures healed primarily. There were
three early amputations. Twelve fractures that healed after six months were
classified as delayed unions and three fractures were classified as
non-unions because of the absence or arrest of healing, as seen on serial
roentgenograms. Additional intervention was used to achieve union of eight
of the fifteen fractures that had been classified as a delayed union or a
non-union. Ten of the forty fractures were associated with infection, but
osteomyelitis developed in only one patient. No patient had a growth
arrest. Only one patient had a limb-length discrepancy that was more than
two centimeters. Three early amputations and one delayed amputation were
performed in patients who had a Grade-IIIC open fracture.
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